Depression 抑郁 If the material we have presented thus far has not already sufficiently suggested it, we can take note here of a continuing preoccupation throughout the whole course of Karen's analysis, namely, with her depression. It was clear from the beginning that there was an underlying depression that lurked beneath her staunch and vigorous defensiveness. From time to time it would show its head sufficiently to be a focus of continuing concern, raising the important question of the extent to which her defenses could be usefully undermined or confronted without exposing her to the risk of an overwhelming depression. 如果我们到目前为止所提供的材料还不足以说明这一点，我们可以在这里注意到，在卡伦的整个分析过程中，始终存在着一种持续的关注，那就是她的抑郁。从一开始就很明显，在她坚强有力的防御之下潜藏着一种潜在的抑郁。时不时地，它会露出足够的头，成为持续关注的焦点，提出一个重要的问题:在不让她暴露于压倒性抑郁风险的情况下，她的防御能力能在多大程度上被有效削弱或面对? She felt sad, helpless and lonely. She was infrequently able to express her sense of weakness, helplessness and deep hurt, but when she did so it only prompted a defensive reaction, since she saw those feelings as wrapped up in her weakness and vulnerability. She felt sick and alone and did not want to look at her loneliness or her sickness. She saw herself as a "lump of frustrated desire," but could not bring herself to speak of the feelings of pain and frustrated longing in her. Sometimes when she drank too much or smoked some pot, the depressive feeling would come out from under its coverings and sweep over her in a wave of melancholia. 她感到悲伤、无助和孤独。她很少能表达出自己的软弱、无助和深深的伤害，但当她这样做的时候，只会引发一种防御性的反应，因为她把这些感觉都包裹在自己的软弱和脆弱之中。她感到快病了和孤独，不想看到她的孤独或她的疾病。她把自己看作是“一团受挫的欲望”，但却无法让自己说出内心的痛苦和受挫的渴望。有时候，当她喝得太多或者抽了一些大麻的时候，抑郁的感觉就会从它的遮盖物下出来，在她身上掀起一股忧郁的浪潮。 At such times she would have a feeling of loathing for herself, seeing herself as vile and hateful and despicable. She felt herself to be rootless and aimless, with nothing in her life but things to complain about and disappointment. She complained, "Where has my youth gone? To be this young and so tied down by responsibilities and obligations is an obscenity." The facade of competence and intellectual superiority that she affected she felt was a sham, as though she were getting away with something, deceiving people, getting credit for something that she simply did not deserve. Underneath the sham facade she felt insecure, helpless, and hatefully corrupt. She felt she always had to be entertaining, and bright, and witty, or otherwise she would not be accepted, she would not be liked. For her it was a surprise when people responded positively to her and seemed to value her. "I keep trying to prove my value, but I simply remain unconvinced." 在这种时候，她会有一种厌恶自己的感觉，觉得自己卑鄙、可恨、可鄙。她觉得自己没有了根，没有了目标，生活中除了抱怨和失望什么也没有。她抱怨道:“我的青春到哪里去了?如此年轻，被责任和义务束缚，是一种猥亵。”她装出一副能干和智力超群的样子，她觉得这是一种假象，仿佛她在做什么事，欺骗别人，为她根本不配得到的东西而获得荣誉。在虚伪的外表下，她感到不安全、无助和可恶的腐化。她总觉得自己必须风趣、聪明、机智，否则就不会被接受，也不会讨人喜欢。对她来说，当人们对她做出积极的回应并似乎重视她时，她感到很惊讶。“我一直在努力证明自己的价值，但我就是不相信。”[这句话说的太好了] At times when her depression was more acute, references to suicide were prominent. In the very first hour she spoke of a suicidal woman who was so much like herself. She also identified with a young coed who was beaten to death and raped—she was so young and alone and vulnerable. She identified herself with an older friend who was chronically depressed and yet had spent so many years in analysis. She felt a sense of envy and outrage at women who attempted suicide to get what they wanted. She saw it as a means of getting attention, of crying that they were hurt and of getting people to respond to the hurt, to take care of them. While there was a part of her that wanted to cry out for help and complain of her hurt, at the same time she despised it as weak, and simpering, and feminine. 当她的抑郁更加严重的时候，她经常会提到自杀。在第一个小时里，她谈到了一个自杀的女人，她和她很像。她也认同一个被殴打致死和强奸的年轻女学生——她是如此年轻、孤独和脆弱。她把自己与一位长期患有抑郁症的老朋友联系在一起，此人花了许多年时间进行精神分析。她对那些企图自杀以得到自己想要的东西的女性感到嫉妒和愤怒。她认为这是一种获得关注的方式，一种为自己受到伤害而哭泣的方式，一种让人们对伤害做出反应、照顾他们的方式。虽然她内心深处有一种冲动，想要呼救，想要抱怨自己受到的伤害，但同时她又鄙视这种冲动，认为它是软弱的、傻笑的、女性化的。 One of the more poignant areas in which these feelings were mobilized centered around her father's death, which occurred early in the analysis. His leaving her intensified her feelings of loss and loneliness and vulnerability. This was another example of how she had been victimized by fate. She complained, "Who am I to be so young and to be without a father." She felt hurt and angered and bitter and resentful. The tears she shed for her father became a vehicle for expressing the sense of outraged betrayal, of being cheated and deprived, of being left alone and weak and vulnerable, feeling a sense of outraged deprivation at having to face the difficulties of life. 这些感情被调动起来的更令人心酸的领域之一是围绕着她父亲的死亡的，这发生在分析的早期。他的离开加剧了她的失落感、孤独感和脆弱感。这是她如何成为命运的牺牲品的另一个例子。她抱怨道:“我这么年轻，又没有父亲，我是谁?”她感到受伤、愤怒、痛苦和怨恨。她为父亲流下的眼泪成了一种载体，用来表达愤怒的背叛感、被欺骗和被剥夺感、被遗弃感、软弱和脆弱感，以及不得不面对生活困难时被气愤的被剥夺的感觉。 A peculiar expression of her feelings of inner pain and of her depressive affect came to a focus in relation to her stomach. On frequent occasions her stomach would growl on the couch, and she became preoccupied with it as well as embarrassed by it. At one point she commented, "My stomach doesn't growl—it cries. It's all the tears I've swallowed through the years." She wondered if she wasn't getting an ulcer, feeling that if anyone lived as she was living, how could they avoid it. She observed, "I'm holding something in, it's seething in there. I'm having stomach cramps—it's pretty easy to get depressed. I'm holding in all the sorrow and frustration and unhappiness." And on one occasion she referred to the "primal scream" and then commented on her rumbling stomach. "It sounds like Dr. Frankenstein's laboratory—bubbling away. My sympathy is on the side of the monster, Dr. Frankenstein's child." When I asked her about the monster she replied with some chagrin, "I shouldn't have mentioned it. It was created and then ignored by Frankenstein. It is ugly—it's all just a bad dream. Frankenstein runs away and there is no one to reciprocate love—it's too ugly and too different. Little girl, do you feel ugly and ignored? Do you feel that you were created and then ignored? The creator just wouldn't make you a mate." It was difficult to avoid the distinct impression that much of Karen's sorrow and depression were related to the fact that indeed she had been created and that her creator had left her and ignored her. 她内心的痛苦和压抑情绪的一种特殊表达方式与她的胃有关。有时她的肚子会在沙发上咕咕叫，她不仅为之感到尴尬，而且还为之全神贯注。有一次她说:“我的肚子不叫——它在哭。这是我多年来吞下的所有眼泪。”她想知道自己是不是得了溃疡，觉得如果有人像她一样生活，他们怎么能避免得了溃疡。她说:“我手里拿着什么东西，它在里面沸腾。我胃疼——很容易抑郁。我把所有的悲伤、沮丧和不快都压在心里。”有一次，她提到了“原始的尖叫”，然后评论了她那隆隆作响的肚子。“听起来像是弗兰肯斯坦博士的实验室在冒泡。我的同情是站在怪物这一边的，弗兰肯斯坦博士的孩子。”当我问她关于怪物的事时，她有些懊恼地回答说:“我不应该提起它的。”它被创造出来，然后被弗兰肯斯坦所忽视。它太丑了——这都是一场恶梦。弗兰肯斯坦跑开了，没有人回报他的爱——它太丑了，太不一样了。小姑娘，你觉得自己又丑又被忽视吗?你是否觉得自己被创造，然后被忽视?造物主不会让你成为伴侣。”卡伦的悲伤和沮丧很大程度上与她确实是被创造出来的，而她的创造者离开了她，忽视了她有关。这点很难不给人明显的印象。